Reviewing Publication Discussing the Frequency of ABO and Rhesus-D Blood Groups in Saudi Arabia
Background: Since the discovery of the blood group in 1901 by Karl Landsteiner, the ABO grouping became an essential element in blood transfusion, followed by the Rh blood group system, which was discovered in 1940 by Landsteiner and Wiener. These two systems are considered the most clinically significant blood groups due to the high immunogenicity of their antigens and the naturally occurring antibodies for the ABO system. Knowledge of the ABO and Rh blood groups distribution is necessary to recruit voluntary blood donors. Additionally, building an effective management unit inventory at both the regional and national levels is also required. Identifying these blood groups, ABO and Rh antigens, are vital for planning effective strategies for transfusion. Objective: This study aims to review the literature on the distribution and frequency of ABO and Rh blood groups in Saudi Arabia and critically assess several standards followed by the selected research, including the sample size, represent ability of the Saudi Arabian population, and the availability of ethical approval. Materials and Methods: A computerized systematic literature search was conducted among the PubMed and google scholar search engines using the following keywords: ABO blood group, RhD blood group, Saudi Arabia, and worldwide, to determine the distribution of ABO and RhD blood groups in Saudi blood donors. Results and Conclusion: 32 publications were included in the current study, and the results indicated that most of the blood donors in Saudi Arabia were male. The most common blood group phenotype was O (51+8%), followed by A (27+4%), B (18+8%), and AB (4+2%). The majority of the blood donors were RhD positive (92+2%). The Frequency of ABO and Rh blood groups in this study were similar to the worldwide incidence. However, there was an insignificant difference between the researches. For these reasons, producing publications on blood groups should be considered and corroborated by the Saudi health authorities on a large scale.
ABO, Blood Group, Saudi Arabia
Blood bank service is a central part of the health service in Saudi Arabia. Daily, erythrocyte units are produced to meet the demands of surgical and emergency cases. There is increasing demand for the universal blood types (O negative) as well as all the rare blood types including A negative, B negative and AB negative. There is a growing concern regarding the supply of those blood types, especially during emergencies . Thus, it is imperative to continuously improve blood donation strategies based on informed statistical analysis of the needs. One of the strategies is to encourage current donors to continue to donate. To inform prospective changes to blood donation policies and strategies, research and evidence is required to make the essential changes to these policies and strategies .
Modelling and future predictions suggests that within the next 10 years blood availability will increase to cover the escalating demand of the growing population . This increase in blood supply meets many challenges and requires new approaches of maintaining future donors, and careful selection of the high demand blood groups. Furthermore, blood stock management across healthcare providers is paramount to minimise waste .
For correct planning and implementation of policies in Saudi Arabia, it is important to be able to determine the frequency and distribution of blood types in the country. Having sufficient knowledge of blood groups availability and distribution will aid in planning stocks and transportation of blood products in blood banks in the region. Several studies also found an association between blood groups genetic and infectious diseases. More recently, several studies found there were associations between blood groups and cancer . In addition to improving the quality and safety of healthcare services provided to patients by reducing many preventable deaths. The frequency of these blood groups varies in the population due to various factors, including race, socioeconomic, marriage, and ethnic groups. Such studies require surveying a large sample size that is representable for the population which include blood donors, patients, and volunteering individuals. Additionally, adhering to the country policies and research governance is essential. Such governance ensures participants security and minimal errors in data including repetition and inaccuracies of sources. Ethical approval from a governmental authority provides validity of the accuracy and sensitivity of the data presented.
Several researchers worked on determining the frequency of ABO and Rh blood groups in Saudi Arabia regions and others restricted their findings on local organisations (Table 1). The standards of those published data vary from study to study. Also, ethical approvals are often overlooked in the selected research. Therefore, this study aims to review the published work regarding the distribution and frequency of ABO and RhD blood groups in Saudi Arabia and critically assess several standards of the previously published work in terms of sample size, representability of the Saudi Arabian population, and ethical approval. Subsequently, the overall frequency and distribution of ABO and Rh groups in the Saudi Arabian population will be compared to other countries.
|||Makkah||Blood donors and patients||48.29||29.91||17.54||4.23||92.2||7.8|
|||Al Madinah||Blood donors||45.3||27.7||18.9||8.1||87.9||12.1|
|||Al Madinah||Blood donors||45.3||27.7||18.9||8.1||87.9||12.1|
|||AL Madinah||Healthy population||46||31.4||16.1||6.5||-||-|
|||West II||Blood donors||50.1||29.7||16.01||4.12||91.31||8.63|
|||East II||Blood donors||51||26||18||4||92||8|
|Average ± STD||47.48 ± 8||26.91 ± 5||20.39 ± 6||5.24 ± 3||91.77 ± 4||8.88 ± 5|
Table1: Demonstrates the distribution of ABO and Rh-D blood groups in various regions and cities of Saudi Arabia This table shows the distribution of ABO and Rh-D blood groups in various regions and cities of Saudi Arabia.
A computerized systematic literature search was conducted among the PubMed and google scholar search engine using the following keywords: ABO blood group, RhD blood group, Saudi Arabia, and worldwide, to determine the distribution of ABO and Rh-D blood groups among the blood donors in Saudi Arabia and worldwide. The retrieved publication list was reviewed manually to identify additional eligible studies published in the English language. The selection of publications for inclusion was performed with the last search in September 2019.
Literature search strategies
Articles available in PubMed, Web of Science, and Google Scholar were searched using the terms (“ABO blood type” OR “ABO blood group” OR “Rh blood type” OR “Rh blood group” OR “blood type” OR “blood group”) AND (“Saudi Arabia” OR “Saudi” OR “KSA”) in June, 2019. Language, date of publication, study design, age, gender, and geography were not restricted.
All manuscripts were combined after removing the duplicates, then titles and abstracts of articles were screened, and full contents of eligible articles were reviewed. Articles were screened by authors independently using eligibility criteria for the review.
All published original studies of any design except review studies that discussed the importance of ABO, and RhD blood group frequency were included. Moreover, studies were excluded from meta-analysis when they lacked sufficient data to estimate the frequency of ABO and Rh data.
For each study, the following information were extracted, the study location, study year, sample size, study design, gender, prevalence of ABO and Rh blood group, participant types, study period, and ethical approval. Four authors extracted data independently, and the degree of discrepancy in data extraction was minimal between the three authors. A discrepancy in the data collection was resolved by researcher consensus.
Following validation of studies that were included in this study, 24 studies (Table 1) determined the frequency of major blood groups (A, B, AB, O and RhD) in Saudi Arabia. Most of the research summarised in Table 1 investigated the frequencies of blood groups at the level of cities and the rest conducted the research on the level of regions (16 and 8 studies respectively).
Also, there are 13 administrative regions in Saudi Arabia and as seen in Table 1 one study investigated the frequency of blood groups in 5 administrative regions and all others focused on one.
Furthermore, the names of the administrative regions were not following the actual official names, which make the determination of the interpretation of certain regions difficult (e.g., western region can include both/either Makkah and/or Madinah administrative regions).
When calculated the average frequency of blood groups showed standard deviation that ranged from 2 to 8 in most cases. Blood groups O and B showed the highest variation followed by blood group A (8 for both O and B and 4 for A) and the lowest variation was seen in the rest of blood groups (AB, Rh +ve and Rh-ve) (Table 1). It can also be noted that there was variation between the frequencies of blood groups in the same regions among two different studies as seen in Table 1.
Table 2 shows the sampling criteria of 24 studies summarised and presented in a chronological order. Here we noted that there were two studies that there are two studies that were conducted in the capital (Riyadh). Interestingly, only three of the studies listed the ethical approval information in their research method. Five of the studies discounted mention of the period of sample collection including studies that has gained ethical approval from a research authority. Most of the samples included in studies compromised of males with exception of two studies that had higher female to male ratio. The sample size varied from 300 to almost 40000 with relatively lower sample size in studies that had mentioned the ethical approval. Also, 9 of the studies were published in the last 10 years and only 4 studies published before 2010.
|Reference||Region / City||Sample Size||Male%||Female%||Main Locations||Period of Sample Collection||Ethical Approval|
|||Riyadh||859||0||100||King Khalid University Hospital||-||Not listed|
|||East II||57196||99.7||0.3||Blood bank department t of king Fahd hospital||(1985-1989); (1995-1999)||Not listed|
|||North||1278||100||0||Different regions of Saudi Arabia||-||Not listed|
|||Arar||686||50||50||Maternity and Children Hospital in Arar city||Nov 2016 – May 2017||Listed|
|||Jeddah||161||-||-||Faculty of Dentistry, King Abdulaziz University||-||listed|
|||Unaizah||502||-||-||King Saud hospital||January 2017 to December 2017||Listed|
|||Southwest||944||100||0||Asser, Jizan and Najran regions||-||listed|
|||Jazan||30481||-||-||Blood Bank Department of King Fahd
Central Hospital in Jazan
|Jan 2002 - Dec 2008||Not listed|
|||Al-juof||400||100||0||Primary Health Centres of four major cities (Sakaka,
Domaht AlJandal (Domah), Al-Qurayat and Sweer).
|||Saudi arabia||66,445||-||-||Retrospective study from different location||-||Not listed|
|||Riyadh II||400||58||42||King Abdualziz Medical City||2013||listed|
|||Al MAdinah||30.7||99.03||0.97||Al-Madinah blood Bank||Nov 2016 – Dec 2016||Not listed|
|||Makkah||4930||-||-||Central blood bank Makkah city||Jan 2014 – Dec 2016||Not listed|
|||Madinah||307||99.35||0.65||Al-Madinah blood bank||Nov 2016 – Dec 2016||Not listed|
|||Riyadh||254||-||-||King Faisal Specialist Hospital and Research||Jan 2010 -Jun 2014||listed|
|||Hail||832||100||0||college of medicine, at university of Hail||-||listed|
|||Hail||440||40.26||59.74||Cardiology Department in Hail region of Saudi Arabia||-||Not listed|
|||Almadinah||1171||49.1||50.9||Online Survey||-||Not listed|
|||Hail||600||41.3||58.7||Hail, baqaa, alghazala, alhaet and alshinan cities||One year 2015||Not listed|
|||Hail II||715||61.7||38.3||-||Sep 2017- May 2018||listed|
|||Najran||593||100||0||Al-Ghad International College for Applied Medical
Sciences in Najran- KSA.
|||West II||35388||-||-||Transfusion medicine section of king Abdelaziz medical
city of national guard, Jeddah
|Feb 2014- Feb 2016||Not listed|
|||Riyadh||205||56||45||Al-Farabi dental Hospital, Riyadh||-||listed|
|||Buraidah||4590||-||-||blood bank centre of Buraidah central hospital||Mar 2017 – Dec 2018||listed|
Table 2: Demographic data of previous studies in various regions and cities of Saudi Arabia. This table shows demographic data of participants of previous studies in various regions and cities of Saudi Arabia.
This project included Thirty-four studies divided and summarized into local Saudi data (24 articles (Table 1), and international findings (23 articles, Table 2). Moreover, local, and international data has been divided into blood donors and non-donors (patients, students, and healthy population) based on study setup. Table 1 demonstrates the distribution of ABO blood group in the different regions of Saudi Arabia and categorizes it by the provinces or the origin of the tribal location of the targeted populations. All research showed an insignificant difference between the ABO and RhD blood groups’ distribution among participants; however, they highlighted that the prevalence of ABO blood group was O>A>B>AB. Additionally, the RhD positive group was the predominate group compared to the RhD negative (91.77 ± 4 and 8.88 ± 5 respectively). Results indicated that the O blood group was the most common group in the Saudi population (51 ± 8% The average distribution of other ABO phenotypes was A (27 ± 4%), B (18 ± 8%), and then AB (4 ± 2%). For Rh blood group, the frequency of RhD positive.
The participants of the previous local studies’ demographic data were summarized in Table 2 to determine the causes of variation in ABO and RhD distribution. The demographic data showed that males were the predominant blood donors in all regions. However, the sample size varies between the studies according to the conducted project scope in a different location in Saudi Arabia. Few blood grouping studies showed a sample size of more than thousand participants. Among these studies, the highest recruitment of blood donors was nearly 38000 from the Western region of Saudi Arabia. Simultaneously, the most recent studies showed a reduction in numbers of the targeted population with almost less than 1000 individuals. Moreover, ethical considerations such as an IRB approval have only appeared in three studies. That highlighted the variances in study protocols and experimental setup, which might be the reason for the differences in ABO and Rh distribution among the Saudi population.
The results recorded by this study were not far from other countries throughout the world (Table 3). Most of the listed countries (23 sites) showed higher O blood group occurrence, but seven countries indicated A as a high distributed blood group in their population. Similarly, the average distribution of Rh group in the Saudi population is following the international frequency with no influence of race and ethnicity.
|Participants||Country||O %||A%||B%||AB%||Rh +%||Rh-%||Reference|
Table 3: The distribution of ABO and Rh-D blood groups in the world and various countries. This table shows the distribution of ABO and Rh-D blood groups in the world and various countries.
No large-scale studies have sought to determine the frequency and distribution of the ABO and Rh on the level of the population of Saudi Arabia although some regional and city-scale studies exist. Researchers in other countries worked on determining the frequencies of the major blood groups in their countries to assist in improvement of policies and regulations of blood banks.
The general frequency pattern of the blood groups follows that of the world, O>A>B>AB and with higher Rh- Positive cases. Here, we found that the variations between the frequency of the blood groups ranged from 2 for AB group, 4 for A and AB groups, and 8 for B and O blood groups. It is expected to find variation between the percentages of blood groups among geographically distributed populations within the same countries. Studies in other locations found similar variation between percentages of blood groups in India, Pakistan, Bangladesh, and the UK .
The variations between the frequencies of blood groups for studies conducted in matching locations were high. Some variation can be anticipated in the same population in the matching location which can result from variation of sample criteria and year in which the sample was collected. All these studies concluded that their data represents the population in the region or city selected for their research. However, the samples in those studies were selected from unrelated population, e.g., one study recruited students of a large number and the other recruited donors in the hospital.
Studies that aim to improve policies of healthcare providers, especially blood banking regulations, require careful selection criteria of samples. Because if a research aims to affect a population needs to select a population that reflect its criteria. Here, we found that the selected populations in the studies failed to reflect the regions blood groups frequencies as they lack the criteria for representation. Some studies selected successful donors which reflect healthy, adult, and generally males. Others selected students in a restricted institution which reflect specific population of the region that has capacity to educate their children in this particular institution. Also, some research selected patients admitted to specific hospital in one city. Thus, it can be concluded that the previous studies did not select participants that represent the city or region in which the study aims to estimate the frequency of blood group in. so, such studies are hardly representable for locations in which they are conducted and they cannot represent the whole country of Saudi Arabia.
Another point for consideration was that these studies could have been aiming to provide recommendations to advance blood banking services in cities and regions of geographic, political, religious or high demand. It was also noted that most studies selected regions of centres of close proximity to the institute in which they conducted the research. Also, there is clear lack of researches that was conducted in central blood banks with exception of Makkah.
Frequency and distribution of blood groups studies in populations need to be governed by the constrictions of tight and ethical bodies. Ethical boards guarantee representability, accuracy, reproducibility, protection of participant’s privacy and adherence to correct research governance guidelines. Otherwise, such researches will not be of benefit at the level of populations.
The sequence of ABO distribution among the Saudi studies is; O>A>B>AB. While the frequency of Rhesus (D) negative is inconsiderable low among the participants. Further, male participants were the predominant in all studies. Cities and regions were not evaluated evidently as the scopes of the articles were different. Similarly, the type of participant and ethical approval was not indicated correctly. For these reasons, producing publications on blood groups should be considered and corroborated by the Saudi health authorities on a large scale.
The blood bank services in Saudi Arabia need to develop innovative strategies targeting blood group determination, especially among females. This is likely to improve blood groups’ evaluation in the region and improve blood management in the hospitals. This also will minimize the collection of unnecessary blood supplies from donors. Similar studies should be undertaken to determine the blood group among Saudi Arabia patients to establish an adequate blood group manufacturing. These studies would collectively provide the national blood bank services with information critical for supply forecasting and blood inventory management.
The authors would like to thank Umm AlQura University of supporting the project.
All authors directly participated in this study's design, data collection and analysis, interpretation of the results, and manuscript drafting and revision.
Conflict of Interest
The authors declared that there is no conflict of interest in this work.
The current project was not funded by any institute.
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2Department of Pathology, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
3Research Department, The Strategic Planning, General Directorate of Health Affairs Makkah Region, Ministry of Health, Makkah, Kingdom of Saudi Arabia
4Medical Genetics Unit, Maternity & Children Hospital, Makkah Healthcare Cluster, Ministry of Health, Makkah, Kingdom of Saudi Arabia
Citation: Saeed M. Kabrah, Arwa F. Flemban, Asim A. Khogeer, Waleed M. Bawazir,Reviewing Publication Discussing the Frequency of ABO and Rhesus-D Blood Groups in Saudi Arabia, J Res Med Dent Sci, 2021, 9(10): 29-37
Received: 04-Sep-2021 Accepted: 22-Sep-2021